Provider Demographics
NPI:1770379919
Name:CORRALES MATERNE, ERIKA
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:CORRALES MATERNE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4165 MOJAVE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-0807
Mailing Address - Country:US
Mailing Address - Phone:575-494-2056
Mailing Address - Fax:
Practice Address - Street 1:4165 MOJAVE DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-0807
Practice Address - Country:US
Practice Address - Phone:575-494-2056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMS2-1397172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker